Is Hemoglobin Level in Patients with Nasopharyngeal Carcinoma Still a Significant Prognostic Factor in the Era of Intensity-Modulated Radiotherapy Technology?

PLoS One. 2015 Aug 27;10(8):e0136033. doi: 10.1371/journal.pone.0136033. eCollection 2015.

Abstract

Background: Hemoglobin (Hb) levels are regarded as an important determinant of outcome in a number of cancers treated with radiotherapy. However, for patients treated with intensity modulated radiotherapy (IMRT), information regarding the prognostic value of hemoglobin level is scarce.

Patients and methods: A total of 650 patients with nasopharyngeal carcinoma (NPC), enrolled between May, 2005, and November, 2012, were included in this study. The prognostic significance of hemoglobin level (anemia or no-anemia) at three different time points was investigated, including before treatment, during treatment and at the last week of treatment. Univariate and multivariate analyses were conducted using the log-rank test and the Cox proportional hazards model, respectively.

Results: The 5-year OS (overall survival) rate of patients who were anemia and no-anemia before treatment were 89.1%, and 80.7% (P = 0.01), respectively. The 5-year DMFS (distant metastasis-free survival) rate of patients who were anemia and no-anemia before treatment were 88.9%, and 78.2% (P = 0.01), respectively. The 5-year OS rate of patients who were anemia and no-anemia during treatment were 91.7% and 83.3% (P = 0.004). According to multivariate analysis, the pre-treatment Hb level predicted a decreased DMFS (P = 0.007, HR = 2.555, 95% CI1.294-5.046). Besides, the mid-treatment Hb level predicted a decreased OS (P = 0.013, HR = 2.333, 95% CI1.199-4.541).

Conclusions: Hemoglobin level is a useful prognostic factor in NPC patients receiving IMRT. It is important to control the level of hemoglobin both before and during chemoradiotherapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anemia / blood
  • Anemia / diagnosis*
  • Anemia / etiology
  • Anemia / mortality
  • Carcinoma
  • Female
  • Hemoglobins / analysis*
  • Humans
  • Male
  • Middle Aged
  • Nasopharyngeal Carcinoma
  • Nasopharyngeal Neoplasms / blood*
  • Nasopharyngeal Neoplasms / mortality
  • Nasopharyngeal Neoplasms / radiotherapy*
  • Neoplasm Staging
  • Prognosis
  • Radiotherapy, Intensity-Modulated / adverse effects*
  • Retrospective Studies
  • Survival Rate
  • Young Adult

Substances

  • Hemoglobins

Grants and funding

This research was supported by grants from the National Science Foundation for Distinguished Young Scholars of China (No.81425018), the National Natural Science Foundation of China (No. 81072226), the 863 Project (No. 2012AA02A501), the National Key Basic Research Program of China (No. 2013CB910304), the Sci-Tech Project Foundation of Guangdong Province (No. 2011B080701034 and No. 2012B031800364), the Sci-Tech Project Foundation of Guangzhou City (No. 2011J4300100), the Sun Yat-sen University Clinical Research 5010 Program and the Fundamental Research Funds for the Central Universities. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.